Factors Affecting Antiretroviral Therapy Adherence among HIV Positive Adolescents and Young Adults in Kilifi North Sub-County, Kilifi County, Kenya

Abstract

In 2019, an estimated 5.1 million adolescents and young people worldwide were living with HIV, with more than 60% based in sub-Saharan Africa. This group records high infection rates despite being critical to future national growth as the workforce. Safeguarding their health requires effective management of HIV/AIDS, where adherence to antiretroviral therapy (ART) remains central. While many global studies highlight factors influencing ART adherence, their frameworks are not suited to the unique realities of Kilifi North Sub-County in Kenya, underscoring the need for localized research. This study therefore investigated factors affecting adherence to ART among HIV-positive adolescents and young adults (AYA) in Kilifi North Sub-County. Its objectives were to determine factors promoting adherence to ART, identify barriers to ART, and propose mitigation strategies towards the barriers to ART. The study adopted a descriptive research design targeting a population of 312,150. Out of this, 3,107 individuals were considered, including 3,029 HIV-positive AYA, 66 healthcare workers, and 12 support groups. A sample of 112 was selected, comprising 97 AYA, 9 healthcare key informants, and 6 support groups. Data collection involved questionnaires for AYA, interviews for key informants, and focus group discussions for support groups. Quantitative data were analyzed descriptively, while qualitative data underwent thematic and content analysis. Ethical standards such as DU-ERB and NACOSTI approvals, informed consent, and confidentiality were strictly upheld. Findings revealed that adherence facilitators included healthcare provider support, counselling, reminders, confidentiality, education, family and peer support, and youth-friendly services. Barriers included substance use, forgetfulness, poor family support, stigma, delayed acceptance of HIV status, and systemic lapses like negative provider attitudes. Mitigation factors were education, disclosure, psychosocial empowerment, supportive clinician relationships, and stigma-reduction policies. Recommendations emphasized home-based ARV delivery, integration of mental health, and financing safeguards through supportive policies. Health systems should train providers in adolescent-friendly care, improve counselling, streamline refill systems, ensure reliable drug supply, and adopt digital reminders. Communities should strengthen peer and family support, expand youth-friendly centers, encourage early disclosure, combat stigma and substance abuse, and build resilience and empowerment. This study informs PLWHIV/AIDs on the obstacles to overcome and elements to encourage adherence to ART for improved health and enlightens the community on realizing the significance of creating a supportive environment for PLWHIV/AIDs. In order to minimize low ART adherence, the study provides information to the national and local governments about mitigation strategies and support systems to adopt. It also adds to the body of knowledge on ART adherence and is helpful for scholars and researchers